Scott affirms support for Medicaid expansion but sticks to pro-business principles on health policy

Gov. Rick Scott says that he has stayed true to his pro-business views on health policy.

TALLAHASSEE — Rick Scott swept into the Governor's Mansion fueled by his scorn for President Barack Obama's health reform law. So, when Scott announced last year that he supported expanding Medicaid — a centerpiece of the Affordable Care Act — the nation was amazed.

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In an interview with the Times/Herald Friday, Scott reaffirmed his support for Florida taking $51 billion in federal money to provide health insurance for up to 1 million poor Floridians. And he said he sees no contradiction in the positions he has taken.

"While they spend 100 percent, I'm not going to stand in the way of the federal government doing something," he said. "What I'm not willing to do is put Florida taxpayers on the hook. … I've been very consistent and let's all remember that Obamacare is an absolute bad bill for patients, for families, for employers, for employees."

Now, as he seeks re-election, Scott said Friday that his pro-business views on health policy — honed as he led the nation's largest hospital chain — are firmly in place.

His actions on health-related issues as governor confirm it:

• At a time when prescription drug abuse continued to be a crisis in Florida, Scott closed the state's Office of Drug Control to save $500,000 a year and criticized the fledgling prescription drug monitoring database as a waste of money and potential violation of privacy.

• In a state grappling with chronic health issues like obesity and infectious diseases, he reduced staff at the state Department of Health and cut back on services.

• Despite negative feedback on a project that let private insurers run the Medicaid program in five counties, Scott backed expanding the plan to the entire state, arguing it would save money and improve care.

• Though nonprofit safety net hospitals such as Tampa General bear the largest burden of caring for the poor, Scott proposed changing the Medicaid formula to shift more money to for-profit hospitals. At the same time, he questioned whether the state needed public hospitals at all.

Scott's critics often accused him of implementing bad policy that hurt Floridians in the course of saving a buck or helping businesses. Then and now, his detractors cite the fraud allegations that contributed to his departure from Columbia/HCA as reason to be wary of Scott's intentions.

"I think any health care policies he supports or implements should be met with skepticism," said John Schilling, the former HCA accountant who reported the company's misdeeds to the government.

"What are his motives and who benefits?'' Schilling wrote in an email to the Times/Herald. "Does the patient and taxpayer benefit? Or does a for profit health care entity benefit?"

The company paid what was then the largest health care fraud fine in U.S. history: $1.7 billion. Scott was never charged or fined.

His supporters believe that he should get more credit for what he accomplished in business.

"There's certainly a lot of things that people will say about his tenure at Columbia/HCA … but my observation of his tenure was that he created a focus on measuring our outcomes that didn't exist before that," said longtime friend Alan Levine, who once worked at an HCA-owned hospital in Pasco County and later headed the state Agency for Health Care Administration under Gov. Jeb Bush.

Even as he has cut some government services, Scott has pushed to ease regulatory limits on other health care providers. Under his tenure, Florida has more transplant and trauma centers, despite critics who fear this proliferation will only increase costs and dilute quality.

"You ought to be able to have choices," he said Friday. "Historically, the free market has improved quality in health care."

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Though the Republican-led Legislature frequently agrees with Scott's priorities, he hasn't always had his way.

He endorsed accepting Medicaid expansion dollars, but the House refused to go along. Public hospitals survive, and a heavy lobbying effort changed his mind on the prescription database.

His administration suffered a nationwide embarrassment in 2012 when a tuberculosis outbreak in Jacksonville was exposed by a newspaper at the same time Scott's administration was closing down the state's only TB hospital. (Dr. John Armstrong, whom Scott appointed state surgeon general, would not comment for this story.)

Yet, Scott faced no greater criticism than over his decision to support — but not fight for — Medicaid expansion.

Conservatives called him "Benedict Arnold." Liberals accused him of providing lip service to gain political cover.

"If he had been more assertive, we might have been more successful," said Linda Quick, president of the South Florida Hospital and Healthcare Association.

Former Gov. Charlie Crist, who hopes to reclaim the office in November, has made his own support for Medicaid expansion a favorite talking point. In an interview Wednesday, he said he knows the Legislature would stand in his way, but he'd use any tools at his disposal — including the budget line-item veto.

"It's not my preferred manner of working with the Legislature, but it's a reality that would exist to say, 'Look, maybe you need a little tough love to do right for the people out there,' " he said.

Scott has never apologized for not pushing harder on Medicaid. His support is carefully limited: He only backs expansion during the three-year period in which the federal government pays all costs.

Plus, his support came only after federal authorities agreed to let Florida fully privatize Medicaid, a Republican priority.

Levine supports Medicaid expansion, but still thinks Scott gets too much blame over its failure in Florida.

"Lots of things he's done in health care, people do not give him credit for," Levine said, listing his focus on cancer research and health care workforce shortages. "Those types of investments, the results come later and it will be well past his tenure when you see the result."